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1.  Effects of Dextromethorphan on reducing methadone dosage in opium addicts undergoing methadone maintenance therapy: A double blind randomized clinical trial 
BACKGROUND:
Dextromethorphan (DM) is an N-methyl-D-aspartate (NMDA) receptor antagonist that may be useful during opiate addiction process, especially in reducing methadone consumption in methadone maintenance therapy (MMT). The goal of the current study was to evaluate the effects of oral administration of DM on reducing methadone dose in MMT used to treat illicit opioid drug abuse.
METHODS:
A double-blinded randomized clinical trial was designed. Seventy two opiate abusers undergoing MMT were randomly divided into two groups. Participants in the intervention group were medicated by DM while those in the control group received placebo. After a 6-week follow-up, methadone consumption dosage, quality of life (QOL) and withdrawal symptoms were assessed and compared between the two groups by repeated measure ANOVA statistical test.
RESULTS:
The mean of methadone consumption in the DM and control groups were 62.7 mg/day (52.7-72.7) and 70.4 mg/day (60.4-80.4), respectively. No statistically significant difference was found between the two groups among the four evaluations made (F = 1.192, P = 0.279). There were not any significant differences in withdrawal symptoms between the two groups (P > 0.05). Total mean scores of QOL in the intervention and control groups were 84.8 (78.7-90.8) and 77.8 (71.8-83.7) (P > 0.05), respectively.
CONCLUSIONS:
Although DM might be useful for opioid dependence treatment, results of the current study did not reveal any statistically significant differences. Therefore, further studies exploring this possibility are needed.
PMCID: PMC3430027  PMID: 22973331
Methadone; Dextromethorphan; Opiate Dependence; Addiction; Maintenance Therapy
2.  The Relationship of Opium Addiction with Coronary Artery Disease 
Objectives:
There is some controversy regarding the effect of opium addiction on the coronary artery disease (CAD). The aim of this study was to determine the association between chronic opium consumption and CAD.
Methods:
This study had a case-control design. The patients recruited to the study were selected from angiography files in Department of Cardiology in Kerman University of Medical Sciences, Kerman, Iran. The comparison was done between CAD patients and normal subjects. Opium addiction was diagnosed by patient self-report and confirmed with interview based on DSM-IV criteria. Odds ratio with 95% confidence interval were estimated by unconditional logistic regression.
Results:
The risk factor of CAD was the same in the two study groups. The significant difference in opium consumption was demonstrated between CAD patients and normal coronary artery subjects (OR=3.8, 95%CI=1.5-9.5). Because of the strong association between cigarette smoking and opium addiction, analysis was done in smoker and non-smoker groups separately. Logistic regression showed opium addiction was the independent risk factor for CAD in non-smokers after adjusting to other CAD risk factors (OR=38, 95%CI=2.7-531.7), but in cigarette smokers opium was not a significant risk factor (OR=13.2, 95%CI=0.85-206.5).
Conclusions:
We confirmed that the opium was an independent risk factor for CAD. Health managers and policy makers should try to aware general population and prepare many preventive programs against substance abuse.
PMCID: PMC3075529  PMID: 21566789
Opium; Coronary artery disease; Angiography; Risk factor
3.  Sex based levels of C-reactive protein and white blood cell count in subjects with metabolic syndrome: Isfahan Healthy Heart Program 
Background:
C-reactive protein (CRP) and white blood cell (WBC) are proinflammatory markers. They are major pathophysiological for the development of metabolic syndrome (MetS). This study aimed to address the independent associations between MetS and WBC counts and serum CRP levels and evaluation of their magnitude in relation to the MetS, based on the sex in the Iranian adults.
Materials and Methods:
In this cross-sectional study, subjects who met the MetS criteria, based on the Adult Treatment Panel III were selected from the Isfahan Healthy Heart Program database. A questionnaire containing the demographic data, weight, height, waist, and hip circumference of the respondents was completed for each person. Blood pressure was measured and the anthropometric measurements were done, and fasting blood samples were taken for 2 h postload plasma glucose (2 hpp). Serum [total, high-density lipoprotein (HDL), and low-density lipoprotein] levels of cholesterol, triglyceride, and CRP as well as WBC counts were determined. The univariate analyses were carried out to assess the relation between the CRP levels, WBC counts with the MetS in both sexes the.
Results:
In men with the abdominal obesity, the higher levels of WBC count, high serum triglyceride and blood glucose levels, a low serum HDL level, and raised systolic and diastolic blood pressure were observed. However, the higher serum CRP levels were only observed in those with the low serum HDL-cholesterol levels. The mean values of the WBC counts were statistically different between the men with and without MetS, but the mean values of the CRP levels were similar between the two groups. In women, the mean values of WBC count and CRP levels were statistically different in the subjects with and without a MetS components (except for the low serum HDL levels and high diastolic blood pressure for the WBC measures and abdominal obesity for the CRP measures) and for those with and without MetS. The age and smoking adjusted changes in the CRP levels and WBC counts correlated with the number of Mets components in the women.
Conclusion:
The findings of this study suggest substantial implications for the prevention and management of the MetS and atherosclerotic diseases, as these involve the suppression of inflammatory conditions rather than the incitement of anti-inflammatory conditions.
PMCID: PMC3818614  PMID: 24250693
C-reactive protein level; metabolic syndrome; white blood cell count
4.  Is Friedewald formula a good estimation for low density lipoprotein level in Iranian population? 
Objective:
Serum low density lipoprotein (LDL) level is an important biomarker for coronary artery disease (CAD). As direct LDL measurement is expensive and not cost effective, especially in a large population, it is estimated by Friedewald formula. Therefore, we decided to compare the direct LDL measurement method with LDL measured by Friedewald formula in a large general population for the first time in Iran. Furthermore, we examined the association of total cholesterol (TCh), triglyceride (TG), and high density lipoprotein (HDL) with LDL.
Subjects and Methods:
This study was conducted on the subjects, aged 11–97 years, in the third phase of Isfahan Healthy Heart Program (IHHP) from three cities: Isfahan, Najafabad, and Arak. A fasting blood sample was taken from all subjects and referred to Isfahan Cardiovascular Research Center (ICRC) laboratory (central laboratory of IHHP) to assess TCh, TG, HDL, and LDL directly. Also, the LDL level was calculated by Friedewald formula, in addition.
Results:
The mean level of LDL by direct method was lower than that calculated by Friedewald formula. The mean difference between the two methods was significant, which was 6.6 ± 15.5 mg/dl difference (t = -42.925, P < 0.0001). There was strong correlation between direct and calculated LDL levels (adjusted R2 = 80.4%). Using regression model, a new formula was found for the estimation of LDL.
Conclusion:
It is concluded that the Friedewald formula overestimates the LDL level compared to the direct method in general Iranian population. It is suggested that LDL measurement be carried out directly, especially in high-risk people. If a formula is necessary for LDL estimation, it is better to obtain an especial formula for each population.
PMCID: PMC3634287  PMID: 23626626
Direct measurement; Friedewald formula; Iiran; low density lipoprotein
5.  A comparison between subpleural patient-controlled analgesia by bupivacaine and intermittent analgesia in post-operative thoracotomy: A double-blind randomized clinical trial* 
BACKGROUND:
The efficacy of subpleural analgesia to reduce postoperative pain intensity in patients after lateral thoracotomy is controversial. In this study, we demonstrated the efficacy of two types of subpleural analgesia.
METHODS:
This prospective, controlled, randomized, double-blind trial was performed in Department of Thoracic Surgery of Alzahra Hospital associated with Isfahan University of Medical Sciences from June 2009 until August 2010. After posterolateral thoracotomy and admission to the ICU, patients were randomly assigned into two groups of subpleural patient-controlled analgesia (SPCA) (0.02 cc/kg/h of 0.5% bupivacaine) and subpleural intermittent analgesia (SIA) (0.1cc/kg/6h of 0.5% bupivacaine). The data regarding age, sex, visual analog scale (VAS) (at 8, 16 and 24 hours after initiation of analgesia), morphine consumption, systemic adverse effects, length of ICU and hospital stay, complications, public health service (PHS) criteria, and cost was recorded. Data was analyzed by Mann-Whitney U-test, repeated measured test, chi-square test and the Fisher's exact test. A p < 0.05 was considered significant.
RESULTS:
The study population consisted of 90 patients. There were no significant differences in sex, age, weight, intraoperative analgesics, duration of one-lung ventilation, and adverse effects between the SPCA and SIA groups. Although pain scores were significantly reduced at 16 hours after the first subpleural instillation of bupivacaine 0.5% with patient-controlled analgesia, comparison between mean pain scores in the two groups at 8 and 24 hours after the first subpleural instillation of bupivacaine 0.5% revealed no significant difference. In addition, no significant difference was found in VAS scores at the three evaluated times (p < 0.05).
CONCLUSIONS:
Optimal use of SPCA bupivacaine for postoperative pain treatment is more effective in pain reduction than SIA bupivacaine. The consumption rate of opioid and bupivacaine was also decreased in SPCA group.
PMCID: PMC3430047  PMID: 22973391
Analgesia; Patient-Controlled; Postoperative; Bupivacaine; Thoracotomy
6.  Epidemiology and trend of cancer in Isfahan 2005-2010* 
BACKGROUND:
Cancer incidence rate is increasing in the world particularly in developing countries. The awareness regarding cancer incidence and distribution helps policy makers and researchers to design comprehensive plan for controlling cancer. The aim of this study was to determine the incidence rate and trend of cancer in Isfahan area, one of the most importance provinces of Iran.
METHODS:
Data of Isfahan cancer registry were derived from 2005 to 2010. Direct standardization through world standard population produced by the world health organization was used and adjusted standard rate (ASR) was calculated. The Poisson regression analysis was employed to estimate cancer incidence trend during 5 years.
RESULTS:
The new cases of cancer were 24771 patients from 2005 to 2010. Mean age of these patients was 56.1 ± 18.0 years and 54.6% were male. Male patients were approximately 7 years older than females. The most frequent cancer was gastrointestinal in men and breast cancer in women. The rate of cancer increased approximately 4 per 1000 population and incidence rate ratio (IRR) was 1.004 (95%CI: 1.002-1.005).
CONCLUSIONS:
The rate of cancer is increasing rapidly in Isfahan province. Cancer control and comprehensive prevention plan for Isfahan is necessary.
PMCID: PMC3430050  PMID: 22973394
Cancer; Incidence; Epidemiology
7.  Metabolic syndrome and health-related quality of life in Iranian population 
BACKGROUND:
To investigate the association between Metabolic syndrome (MetS) and Health related quality of life (QoL) in Iranian population.
METHODS:
We used data from the post-intervention phase of Isfahan Healthy Heart Program (IHHP), a community trial for cardiovascular disease (CVD) prevention and control. We recruited 9570 healthy adults, aged ≥ 19 years who were randomly selected using multistage random sampling method. World Health Organization QoL questionnaire (WHOQOL-BREF) which contains 26 items was used to assess QoL. It assesses four domains of QoL; Physical health, Psychological health, Social relationship and Environmental issues. MetS was defined based on ATP III criteria.
RESULTS:
The mean age of participants was 38.8±15.6 years (mean ± SD) and the prevalence of MetS was 22.5%. From all participant 18.2% were illiterate and 13.2% had university educational level. Two way multivariate analyses of covariance (MANCOVA) test after adjusting age showed significant difference between women with and without Mets in regard to physical health and social relations domains, while none of QoL domains was different in men with Mets in comparison to men without it.
CONCLUSIONS:
After adjusting the role of socio-demographic factors as components of QoL score, no association was observed between QoL domains and MetS in men, while only social relations and physical health scores were higher in women with Mets compared to those without Mets. Other variety of health-related QoL assessment tools or definitions of MetS may show different relationship in the Iranian socio-cultural context.
PMCID: PMC3214330  PMID: 22091241
Metabolic syndrome; Quality of life; General population
8.  Prognostic Factors for Survival at 6-Month Follow-up of Hospitalized Patients with Decompensated Congestive Heart Failure 
ARYA Atherosclerosis  2010;6(3):112-117.
BACKGROUND
The prevalence of Congestive Heart Failure (CHF) is increasing in recent years. Factors associated with mortality in CHF patients are important to be determined in order to select therapeutic modality by physicians. The purpose of the current study was to declare predictors of 6-months survival in patients hospitalized for decompensated CHF in Isfahan.
METHODS
A cohort of 301 hospitalized patients with decompensated CHF were recruited in this study. The diagnosis of CHF was based on previous hospitalizations and Framingham criteria for heart failure (HF). Information regarding past history, accompanying diseases such as cerebrovascular accidents (CVA), chronic obstructive pulmonary diseases (COPD), clinical data, medications and echocardiography were obtained by a cardiologist. Patients were followed for their survival for 6 months by telephone calls. Kaplan-Meier method was used for uni variate survival analysis and Cox proportional hazard model was used for multivariate analysis.
RESULTS
Mean age of patients was 71.9 ± 12.2 years and 59.8% was male. During 6-months follow-up 138 (45.8%) patients died. Mean survival was 119.2 ± 4.4 days (Mean ± SEM). Significant prognostic factors for 6 months survival were high education level (HR = 0.74, CI 95% 0.59—0.93), COPD (HR = 1.91, CI 95% 1.2—3.04), CVA (HR = 1.69, CI 95% 1.03—2.78), Angiotensin Converting enzyme (ACE) inhibitors use (HR = 0.44, CI 95% 0.3—0.66) and Diuretics (HR = 0.63, CI 95% 0.41-0.96).
CONCLUSION
Six-month survival of hospitalized decompensated CHF patients in Iran is not favorable. Many factors particularly accompanying diseases and medications affected the patient's 6-months survival.
PMCID: PMC3347826  PMID: 22577426
Heart failure; Survival; Mortality
9.  How effective are strategies for non-communicable disease prevention and control in a high risk population in a developing country? Isfahan Healthy Heart Programme 
Introduction
The Isfahan Healthy Heart Programme (IHHP) is a community-based programme for non-communicable diseases prevention and control using both a population and high risk approach in Iran. This study demonstrated the efficacy of IHHP interventional strategies to improve lifestyle behaviours in a population at risk for developing cardiovascular diseases.
Material and methods
Healthy Lifestyle for NCDs High Risk Population is one of ten projects of IHHP. High risk individuals were defined as those who have at least one risk factor for developing coronary artery disease (CAD). Changes of behavioural indicators have been compared between two areas with a survey after 5 years of intervention.
Results
Among high risk individuals in the intervention and reference areas, 77.8% and 82.5% had at least one major risk factor for CAD. The prevalence of major risk factors for CAD (except cigarette smoking) was decreased in both intervention and reference areas during 5 years of intervention and the pattern of diet and physical activity was improved.
Conclusions
Interventional activities in IHHP targeting the high risk population seem to be effective in improving lifestyle behaviour, increasing awareness and control of risk factors of the high risk population.
doi:10.5114/aoms.2010.13503
PMCID: PMC3278939  PMID: 22371716
coronary artery disease; risk factor; healthy lifestyle; community interventions; developing country; Iran

Results 1-9 (9)